24.2, Injuries to the Hip
Table of Contents

FUNCTIONAL PERFORMANCE TESTING OF THE HIP

Abstract:

This unit discusses functional performance tests and their reliability and validity for patients with hip dysfunction. The assessments cover the categories of movement, balance and postural control, hop/jump, and field agility tests. Selection and interpretation of each functional performance test support the detection of hip dysfunction and aid in determining treatment progression. The unit also addresses the use of cutting edge functional performance tests to assist in differential diagnosis of hip-related pathology. CASE ANALYSES: Three intriguing case studies are presented. Each case highlights strong clinical reasoning and proper care. The first case involves a 19-year-old female Broadway dancer complaining of pain and a sense of instability in her right hip. The second case describes a 44-year-old female who is referred to physical therapy for ongoing complaints of posterior-lateral hip pain that radiates into the buttock. The third case clearly details a pre-participation screening exam of a 22-year-old male collegiate hockey player.

Keywords:​

reliability, validity, dysfunction

References:

Click here.

HIP ARTHROSCOPY AND REHABILITATION

Abstract:

A brief overview of the history of hip arthroscopy and its extensive use today in orthopaedics introduces this topic. The authors review key anatomical structures of the hip complex and their relationship to hip pathology. They stress the importance of delineating hip joint pathology from the surrounding entities during the diagnostic process to identify and classify hip injuries. They also discuss operative and nonoperative treatments for each pathology. A 4-phase postoperative rehabilitation guideline is presented so the reader can gain insight for the 11 underlying principles of healing and function that the authors advocate. CASE ANALYSES: Two postoperative cases are presented. The first involves a 24-year-old male who initially presents with left hip pain and lumbar discomfort following completion of a marathon. The second case describes a 17-year-old, right-hand dominant pitcher who complains of right hip pain.

Keywords:​

hip complex, joint pathology, diagnostic process

References:

Click here.

EXAMINATION AND DIFFERENTIAL DIAGNOSIS OF HIP INJURY

Abstract:

This unit begins with coverage of hip injuries from anatomical and biomechanical perspectives. The author then encourages an exam process that emphasizes thorough history taking and comprehensive movement testing to arrive at a differential diagnosis. Tests and measures using an evidence-based approach are highlighted throughout. Priority is placed on identifying unique symptoms associated with certain hip pathologies. Referred hip pain arising from musculoskeletal tissues of the lumbar and pelvis is discussed. The authors cover several pathologies for each diagnostic classification, including femoroacetabular impingement, labral tear, osteoarthritis, and snapping hip syndromes. CASE ANALYSES: Two cases enable application of the previously covered content. The first involves a 32-year-old female who complains of anterior and lateral hip pain with occasional radiating pain into her buttock. The second case describes a 51-year-old male who complains of an insidious onset of right lateral hip pain and buttock pain and “tightness.”

Keywords:​

movement testing, femoroacetabular impingement, labral tear

References:

Abstract:

CONTENT: This unit first reviews the functional anatomy and kinesiology of the hip. This knowledge then forms the basis for enhancing the reader's understanding of normal hip function during ambulation and how to prescribe therapeutic exercises. Referenced electromyographic studies of the hip provide evidence for the approach advocated in the unit. The authors include a supplemental booklet containing photos of several exercises for hip rehabilitation. The majority of these exercises also appear as video clips online. This approach provides the reader with a unique learning resource. CASE ANALYSES: Three cases studies are provided. The first case describes a 55-year-old female who underwent right total knee arthroplasty 4 weeks prior to beginning physical therapy. The second case details a 44-year-old hockey coach who presents with a history of right hip pain along with a recent injury caused when one of his players collided with him on the ice. The third case describes a 21-year-old college female who suffers from right anterior hip pain for 2 months, but also desires to run in an upcoming triathlon. This case is accompanied by a pre- and posttreatment online video showing the patient's running gait.

Keywords:​

kinesiology, anatomy, ambulation

References:

Click here.

THE HIP THROUGHOUT THE LIFE CYCLE

Abstract:

CONTENT: Hip pain and pathology occurs in the infant, adolescent, and adult. This unit covers normal developmental morphology of the femur and acetabulum and growth factors that can lead to hip pathology and pain in each of these age groups. The authors then review common nonsurgical treatment approaches. In addition, the long-term sequelae of an abnormal hip structure are considered in the context of early degeneration of the hip joint and disability. The unit then delves into a review of the operative management for degenerative hip disease. Total hip arthroplasty and hip resurfacing procedures are discussed in detail, along with the proper stages of postoperative rehabilitation. The authors emphasize an evidence-based practice approach to treatment planning. CASE ANALYSES: Two cases are presented. The first study involves a 6-year-old boy who has a persistent limp that is attributed to Legg-Calve-Perthes Syndrome. The second case discusses the pre- and postoperative treatment of a 60-year-old active female with hip osteoarthritis who has undergone total hip arthroplasty.

Keywords:​

morphology, growth factors, degeneration

References:

Click here.

HIP BIOMECHANICS DURING SPORT

Abstract:

This unit begins by describing the importance of kinetic linking and the key role the pelvic and hip complexes play, not only in optimizing motion, but also in transferring forces. The popular “layer concept” is presented as a systematic approach in the evaluation and treatment of hip pain and explains the contribution of compensatory mechanisms. The authors review the fundamental sporting movements of running, jumping and landing, kicking, hitting, throwing, squatting, lunges, and skating. Each movement is detailed in terms of normal mechanics, the impact of abnormalities on the movement, and strategies to modify the movement in order to successfully address these abnormalities. Rehabilitation and training considerations emphasize properly transitioning the patient/client from the rehabilitation setting to the training setting, and eventually to the sport-specific competitive arena. This staging enables proper planning and implementation of modifications for injured athletes so that they may safely return to training and sport. CASE ANALYSES: Two interesting case studies are presented. The first case describes a professional football lineman with femoroacetabular impingement of the right hip, and femoroacetabular impingement and subspine impingement of the left hip. The second case is a right-handed Division I collegiate softball pitcher who presents with dysplasia of the right hip.